Many People at Risk for Type 2 Diabetes but Don't Know It

Posted on December 6, 2013

Only three in 10 adults 40 and older who have modifiable risk factors for diabetes think they have “a great deal” or “some” risk for diabetes, according to recent American Diabetes Association studies. In fact, four in 10 at-risk adults believe they have no risk for diabetes or prediabetes. Provider perceptions support this; only one in four believes at-risk patients are “extremely” or ”very” knowledgeable about their elevated risk for type 2 diabetes or heart disease. The surveys were conducted with 1,426 consumers aged 40 and older and 601 health care providers.

Cardiometabolic risk is a group of factors that are good indicators of a patient’s overall risk for type 2 diabetes and heart disease. While some risk factors cannot be controlled (age, race/ethnicity, gender, family history), patients do have control over other risk factors (weight, unhealthy cholesterol levels, high blood pressure, smoking, sedentary lifestyle, unhealthy diet and high blood glucose [sugar] level.)

Not surprisingly, since most at-risk patients don’t recognize or acknowledge their elevated risk, most are not at goal for key risk factors. Weight and physical activity were the risk factors with the lowest at-goal rates. “This points to a serious disconnect since weight and physical activity are two risk factors that more than half of at-risk patients discuss with their providers regularly,” said Virginia Peragallo-Dittko, RN, BC-ADM, CDE, FAADE, Incoming Chair of the Association’s Prevention Committee.

Less than half of at-risk patients report discussing “internal” metrics (such as blood glucose, blood pressure and cholesterol) regularly with their providers, and don’t recall them being tested as often as providers report actually measuring them. On the other hand, providers report discussing diabetes and heart disease risk reduction with most of their at-risk patients, and reveal that some patients actually ask about particular risk factors, like blood pressure and weight.

The surveys suggest risk factor reduction discussions may not register with patients because patients are not connecting the risk factors to disease development. On one hand, patients do know what helps lower diabetes and heart disease risks, citing “healthier diet” and “more exercise.” On the other hand, many of the at-risk are overweight or obese (69.6 percent) and/or sedentary (37.2 percent).

Providers report high BMI and sedentary lifestyle are the risk factors most likely to lead to diabetes and heart disease. In fact, the top three cardiometabolic risk factors providers treat are high blood pressure, elevated blood glucose and overweight/obesity.

“These findings suggest it is critical for providers to connect the dots with patients between risk factors and disease development,” said Peragallo-Dittko. “Providers think their at-risk patients are making the link between risk factors and heart attack, diabetes and death, but a quarter of these patients report they don’t even have any health problems. We have to close the gap if we want to prevent future development of type 2 diabetes and heart disease.”

Providers say the greatest barrier to treating their at-risk patients is noncompliance with lifestyle modification recommendations, because patients “don’t take their risk seriously,” or “are in denial.” Nearly 80 percent of at-risk patients think they are in “excellent” or “good health,” even though they don’t regularly implement good health habits and don’t believe they are at risk, or have control over lowering their cardiometabolic risk. Peragallo-Dittko emphasized that “providers have an opportunity when reviewing test levels to tell patients exactly what these numbers mean and how they contribute to disease development.”

In an effort to educate and empower people to take action for their health, the American Diabetes Association implements CheckUp America, a national prevention initiative aimed at helping Americans learn how to lower their risk for type 2 diabetes and heart disease. CheckUp America works to help people manage these factors and thereby reduce disease risk through public and physician education campaigns, in addition to online, interactive resources.

The American Diabetes Association’s CheckUp America initiative is supported in part by Bristol Myers-Squibb Company and Janssen Pharmaceuticals Inc.

These studies were conducted through the Association’s CheckUp America initiative. The consumer survey was conducted through a telephone omnibus survey with 1,426 adults aged 40 and older (half male, half female) in April 2013. The health care provider survey was taken online by 601 primary care physicians, nurse practitioners and physician assistants in June 2013.